Purpose: Congenital tracheal atresia is a rare anomaly (1:50.000). The defect consists of
partial or complete absence of the trachea below the larynx. The lower airway often
is connected to the gastrointestinal tract via a distal tracheo- or bronchoesophageal
fistula.
Material and methods: This is a case report of an extremely rare combination of tracheal and esophageal
atresia with fatal outcome.
Results: A 32 years old women (gravidity 2/parity 0) presented with suspected esophageal atresia
in 32+0 weeks of gestation. Secondary diagnoses were gestational diabetes and hypertension.
Ultrasound examination revealed polyhydramnios, absent stomach and amniotic sac prolapse.
There were no further sonographic abnormalities. Antenatal corticosteroids were given
and amniodrainage because of labour was necessary twice (32+2 and 33+4 gestational
weeks). Preterm premature rupture of the membranes and labour occurred with 36+5 weeks
of gestation. Emergency caesarean section for abnormal fetal blood analysis was conducted,
and the newborn was resuscitated because of no audible cry and fetal bradycardia.
Despite multiple attempts intubation and ventilation failed. So, resuscitation was
stopped after 60 minutes. The autopsy revealed non-ventilated lungs and a combined
tracheal and esophageal atresia. A tracheoesophageal fistula below the atresia was
found. Therefore, CHAOS did not develop prenatally. There were no further malformations.
Conclusions: Combined tracheal and esophageal atresia can be very difficult to detect prenatally
which results in high risk for fatal outcome.
